Immediate Implant-Based Breast Reconstruction following Total Skin-Sparing Mastectomy in Women with a History of Augmentation Mammaplasty

Sbitany, Hani; Wang, Frederick; Saeed, Lina; Alvarado, Michael; Ewing, Cheryl A.; Esserman, Laura J.; Foster, Robert D.

doi:10.1097/prs.0000000000000293

Cited by 25 publications

(13 citation statements)

References 12 publications

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“…Prior radiation therapy has been studied as a risk factor for skin and wound complications after mastectomy 9,17,19,33,34 , and is underrepresented in our study population, with only 7% of patients having prior radiation. We also have no specific data on traction injury, though flap length, incision size, and time to specimen removal may be surrogates of this.…”

Section: Discussionmentioning

confidence: 99%

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

et al. 2015

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Background Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can impact cosmetic outcomes and patient satisfaction, and, in worst cases, potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. Methods We designed a prospective study to capture the rate of skin flap necrosis and pre-, intra-, and post-operative variables with follow-up to 8 weeks post-operatively. Univariate and multivariate analyses were performed for factors associated with skin flap necrosis. Results Out of 606 consecutive procedures, 85 (14%) had some level of skin flap necrosis: 46 (8%) mild, 6 (1%) moderate, 31 (5%) severe, and 2 (0.3%) uncategorized. On univariate analysis for any necrosis, smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal were significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. When looking only at moderate or severe necrosis, BMI, diabetes, nipple-sparing mastectomy, specimen size, and expander size were significant on univariate analysis. Nipple-sparing mastectomy and specimen size were significant on multivariate analysis. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Conclusions Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.

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Section: Discussionmentioning

confidence: 99%

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

et al. 2015

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“…They concluded that immediate tissue expander/implant reconstructions are an acceptable option for patients requiring PMRT. More recently Sbitany et al in evaluating the morbidity associated with immediate implant reconstruction in 580 patients undergoing nipple-sparing mastectomy with or without radiation found significantly higher infections (21.6% vs 13.1%) and expander/implant losses (18.75% vs 5.1%) in radiated patients 10 . They concluded that immediate implant reconstruction in the setting of pre- or post-mastectomy radiation is a safe operation.…”

Section: Discussionmentioning

confidence: 99%

“…Hirsch et al similarly reported a 50% complication rate in patients who undergo reconstruction after PMRT 5 . In spite of these findings, multiple studies in recent years have endorsed favorable outcomes of implant reconstruction of the radiated breast and this suggests that there may be a growing acceptance of this reconstructive approach 8–10 . Implant reconstructions do provide distinct advantages including shorter operative times, less technically demanding operations, the avoidance of donor sites and potential for a shorter recovery relative to flap alternatives.…”

Section: Introductionmentioning

confidence: 99%

Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards

et al. 2015

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BACKGROUND Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear however, whether this widely-recognized mantra of breast reconstruction is observed in practice. The aim of this study is to evaluate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy. METHODS Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariable and multiple logistic regression analyses were performed to study the odds of implant or combined implant-tissue reconstruction over tissue only reconstruction based on demographic and oncologic characteristics. RESULTS A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. The reconstruction rate among patients requiring radiation increased from 13.6% to 25.1%. The percentage of reconstructed patients who had implant only reconstruction increased from 27% to 52% (p<0.001) with a decrease in tissue only reconstruction from 56% to 32% (, p<0.001); combined implant-tissue reconstructions remained stable at an average of 13%. In regression analysis, the odds of implant reconstruction over autologous reconstruction increased each year by an odds ratio of 1.13 (95% CI 1.10–1.15). CONCLUSIONS The frequency of immediate reconstruction continues to increase in the setting of radiation therapy with a larger proportion of patients undergoing immediate implant-based reconstruction, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of radiation. LEVEL OF EVIDENCE I

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“…In contrast, postoperative XRT had a negative effect on satisfaction with breasts and sexual well being (Table 6 ), a finding that supports prior BREAST-Q analyses by Ho et al 21 and McCarthy et al 23 This decrease in sexual well being may ultimately be linked to poor satisfaction with their breast cosmesis, as XRT causes chest-wall distortion and capsular contractures that can introduce asymmetry and compromise aesthetics. 42 …”

Section: Discussionmentioning

confidence: 99%

A Prospective Study Assessing Complication Rates and Patient-Reported Outcomes in Breast Reconstructions Using a Novel, Deep Dermal Human Acellular Dermal Matrix

Oliveira

Mayer

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:The value proposition of an acellular dermal matrix (ADM) taken from the deep dermis is that the allograft may be more porous, allowing for enhanced integration and revascularization. In turn, this characteristic may attenuate complications related to foreign body reactions, seromas, and infection. However, this is juxtaposed against the potential loss of allograft structural integrity, with subsequent risk of malposition and extrusion. Despite the active use of novel, deep dermal ADMs, the clinical outcomes of this new technology has not been well studied.Methods:This is a prospective study to evaluate surgical and patient-reported outcomes using a deep dermal ADM, FlexHD Pliable. Surgical outcomes and BREAST-Q patient-reported outcomes were evaluated postoperatively at 2- and 6-month time points.Results:Seventy-two breasts (41 patients) underwent reconstruction. Complication rate was 12.5%, including 2 hematomas and 7 flap necroses. One case of flap necrosis led to reconstructive failure. Notably, there were no cases of infection, seroma, or implant extrusion or malposition. Average BREAST-Q scores were satisfaction with outcome (70.13 ± 23.87), satisfaction with breasts (58.53 ± 20.00), psychosocial well being (67.97 ± 20.93), sexual well being (54.11 ± 27.72), and physical well being (70.45 ± 15.44). Two-month postoperative BREAST-Q scores decreased compared with baseline and returned to baseline by 6 months. Postoperative radiation therapy had a negative effect on satisfaction with breasts (P = 0.004) and sexual well being (P = 0.006).Conclusions:Deep dermal ADM is a novel modification of traditional allograft technology. Use of the deep dermal ADM yielded acceptably low complication rates and satisfactory patient-reported outcomes.

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Immediate Implant-Based Breast Reconstruction following Total Skin-Sparing Mastectomy in Women with a History of Augmentation Mammaplasty

Abstract: Risk, II.

Cited by 25 publications

References 12 publications

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards

A Prospective Study Assessing Complication Rates and Patient-Reported Outcomes in Breast Reconstructions Using a Novel, Deep Dermal Human Acellular Dermal Matrix

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